New strategies and methods for reconstruction of the outer ear canal (OEC).

Background: The incidence of re-stenosis or re-atresia after reconstruction of the Outer Ear Canal (OEC) in patients with Congenital Malformation of the Middle and Outer Ear (CMMOE) is very high (up to 48%), and it has been a difficult problem for otologists not being able to solve.Aims/Objectives: To explore new strategies and methods to improve re-stenosis or re-atresia after reconstruction of the OEC in patients with CMMOE.Material and Methods: According to the characteristics of reconstructed OEC (r-OEC) re-stenosis or re-atresia summarized by us, a number of new prevention strategies and methods have been proposed and related patent products have been designed, including the improvement of covering epithelium types and skin grafting methods (7 types), simulated drum ring function to prevent the formation of negative pressure in the cavity, and strengthen postoperative support to reduce skin shrinkage and bone hyperplasia. The postoperative effects of different ages and preoperative OEC malformations are statistically analyzed.Results: The incidence of re-stenosis/re-atresia is 14.3% (5/35) in the thin sectional skin of the temporal scalp overlap splicing skin grafting, which was significantly better than 45.5% (15/33) in the whole piece mosaic splicing and barrel skin grafting from the inner thin sectional thigh skin and overlay splicing other methods, including the inner thigh thin sectional skin, chest medium thick skin and subcutaneous pedicle + chest medium thick skin (p<0.05). The patent artificial drum ring and the model stent of the OEC have obvious effects. The mean operation age of postoperative atresia, stenosis, and good groups are 9.3, 13.1, and 12.5 years old, respectively. The proportion of preoperative atresia is 91.3%, 85.7%, and 57.7%, respectively. The total incidence of re-atresia and re-stenosis of r-OEC for two groups of atresia and stenosis of OEC before surgery is 40.5% (49/121) and 13.3% (8/60), respectively.Conclusions and Significance: The best result is found in overlapping the splicing thin sectional skin of the temporal scalp, combined with artificial drum ring implantation, effective support of postoperative model stent of OEC and post-pubertal surgery selection are new and effective strategies and methods to prevent re-stenosis or re-atresia of r-OEC. Atresia or stenosis of the OEC before the operation is the influence factor of the postoperative effect.

Innovated surgery incision for patients of congenital malformation of the middle and outer ear with infection (CMMOEI).

BACKGROUND: It is the challenging clinical issue of combining debridement of infected lesions and retaining the blood skin flap for auricle reconstruction in patients of Congenital Malformation of the Middle and Outer Ear with Infection (CMMOEI). AIMS/OBJECTIVES: To innovate and introduce an surgery incision to solve the challenging clinical issue of a combined debridement of infection yet retaining a well vascularized skin flap for auricle reconstruction in patients with CMMOEI. MATERIAL AND METHODS: A combined innovated incision of ear sulcus and prefabricated earlobe was used for 23 cases (23 ears) with CMMOEI, The success in the management of the encountered infections, and the short and moderate-term outcome of the innovated incision to preserve a well-vascularized skin flap for subsequent auricle reconstruction were reviewed. The 23 cases include 10 males and 13 females, aged 4-14 years (mean 8.4 years), 7 left ears and 16 right ears. 14 ears stenosis and 9 ears atresia of the outer ear canals. RESULTS: In all 23 cases, the infections were successfully cleared without recurrence or complication with 2-year follow-up. The local skin flap and its blood supply were well preserved for subsequent auricle reconstruction. CONCLUSIONS AND SIGNIFICANCE: The new incision can facilitate clearance of infection in CMOMEI patients, and preserve the retroauricular tissues for subsequent harvesting of a well-vascularized skin flap for subsequent auricle reconstruction.

The significance of masking for the poor hearing ear in pure tone audiometry.

BACKGROUND: In pure tone audiometry, when the difference of the Average Air Conduction Threshold of pure tone (AACT) between bilateral ears is more than 40 dB HL masking must be performed on the poor side, However, we found that masking also make significance difference when the binaural AACT difference (AACT-d)was less than 40 dB HL in some patients. AIMS/OBJECTIVE: Assessing the significance of masking for the poor ear in pure tone audiometry in patients with different types of deafness to obtain preoperative accurate hearing. MATERIAL AND METHODS: A comparative analysis of 163 cases (163 ears) with hearing difference between two ears was conducted, who were divided into three groups: G1 Congenital Malformation of the Middle and Outer Ear (CMMOE)as conductive deafness, 63 ears, G2 sudden deafness as sensorineural deafness, 65 ears, and G3 media otitis as conductive or mixed deafness,35 ears. AACT-d before and after the poor ear masking was analyzed under the following three conditions: (1) 0.125-8 KHz each frequency, (2) 0.5-4 KHz on average, (3) the frequencies of AACT-d ≥ 40 dB HL and <40 dB HL between the two ears before masking. If the sample data did not follow a normal distribution, the Wilcoxon rank sum test was used for comparasion of AACT, and p < 0.05 was considered statistically significant. It is clinically effective for AACT-d ≥ 15 dB HL at 1 frequency or 10 dB HL ≤ AACT-d at 2 frequencies <15 dB HL before and after masking. RESULTS: Among the three groups, (1) the comparasion of AACT-d before and after the poor ear masking for each frequency of 0.125-8 KHz and 0.5-4 KHz on average with all p < 0.05, and the AACT-d of the G1 group was the largest, with an average 0.5-4KHz of 7.5 dB HL, and the first two were 14.5 dB HL and 13.8 dB HL at 0.125 KHz and 0.25 KHz, respectively. (2) AACT-d ≥ 40 dB HL and <40 dB HL between the two ears before masking were distributed at the full frequency of 0.125-8KHz, the clinically effective rates of ≥40 dB HL groups were G1 (89.3%), G2 (45.5%) and G3 (5.3%), while those of < 40 dB HL groups were G1 (69.7%), G2 (34.4%) and G3 (31.3%), respectively. CONCLUSION AND SIGNIFICANCE: For all three groups, there was statistically significant in AACT-d before and after the poor ear masking across each frequency of 0.125-8 KHz and on average 0.5-4 KHz. The distribution of AACT-d ≥ 40 dB HL and <40 dB HL between the two ears before masking was observed throughout the full frequency range of 0.125-8 KHz. AACT-d before and after the poor ear masking showed clinical effectiveness in all three groups, with the highest effective rate observed in the G1 group and the highest AACT-d at 0.125 KHz and 0.25 KHz. Therefore, regardless of whether the AACT-d between the two ears before masking is ≥40 dB HL or <40 dB HL, the full frequency masking should be employed in three groups, especially for the G1 group of CMMOE, particularly at 0.125 KHz and 0.25 KHz.

Study of hearing features of Congenital Malformation of the Middle and Outer Ear (CMMOE).

Background: There is no study on the hearing features of congenital malformation of middle and outer ears (CMMOE), including classification, grades, and frequency characteristics, which play a decisive role in the selection of precise hearing solutions for patients. Aims/Objectives: To analyze the hearing features of CMMOE and provide guidance for clinical practice.Material and Methods: 298 cases (351 ears) with CMMOE were retrospectively analyzed for the features of 0.5 ∼ 4KHz pure tone hearing, including the classification, grades and frequency characteristics. Results: We observed conductive deafness in 84.3% (296/351), mixed deafness in 15.7% (55/351), and 0% (0/351) sensorineural deafness. Grades measured by average Air Conduction Thresholds (ACT) of pure tone: Mild deafness (26-40dB HL) 0.6% (2/351), moderate deafness (41-55dB HL) 10.3% (36/351), moderate to severe deafness (56-70dB HL) 46.1%(162/351), severe deafness (71-90dB HL) 39.9%(140/351), extremely severe deafness (> 90 dB HL) 3.1%(11/351). The average ACT of 296 ears conductive deafness was 67 ± 10 dB HL, of which 56-80dB HL accounted for 78.1% (274/351). In 55 ears with mixed deafness, 32 ears (32/55 = 58.2%) increased Bone Conduction Threshold (BCT) at a single frequency, and out of 32 ears, 31ears (31/55 = 56.4%) ≤40dB HL, 25(25/32 = 78.1%) ears at 2KHz. In 55 ears with mixed deafness, 87.3% (48/55) increased BCT at 2KHz, and the average BCT was 35 ± 10dB HL. Conclusions and Significance: CMMOE result mainly in conductive deafness, moderate to severe and severe deafness. In mixed deafness, the BCT increased mainly at a single frequency, 2KHz and ≤40dB HL. These data suggest that bone-conductive hearing devices are a good solution for CMMOE hearing impairment.

Application of Bis-Adducts of Phenyl-C61 Butyric Acid Methyl Ester in Promoting the Open-Circuit Voltage of Indoor Organic Photovoltaics.

Fullerene-based indoor OPVs, particularly phenyl-C61 butyric acid methyl ester (PCBM), has been regarded as a prospective harvesting indoor light energy source to drive low-power consumption electronic devices such as sensors and IoTs. Due to the low tunability of its inherently spherical structure, the performance of the fullerene-based indoor OPVs seem to hit a bottleneck compared with the non-fullerene materials. Here, we explore the potential application of fullerene derivative bis-PCBM in indoor OPVs, which owns a higher the lowest unoccupied molecular orbital (LUMO) level than PCBM. The results show that when blended with PCDTBT, bis-PCBM devices yield a high VOC of up to 1.05 V and 0.9 V under AM 1.5G illumination and 1000 lx indoor light, compared with the corresponding values of 0.93 V and 0.79 V for PCBM devices. Nevertheless, the disorders in bis-PCBM suppress the JSC and FF and, therefore, result in a lower efficiency compared to PCBM devices. However, the efficiency and stability differences between the two kinds of cells were much reduced under indoor light conditions. After further optimization of the material composition and fabrication process, bis-PCBM could be an alternative to PCBM, offering great potential for indoor OPV with high performance.

Mitigating the Health Effects of Aqueous Cr(VI) with Iron-Modified Biochar.

A large amount of chromium (Cr) has entered the natural environment from the wastewater and waste residues, and the hexavalent (Cr(VI)) is highly poisonous, threatening the ecological environment and human health directly. In this study, iron-modified biochar was prepared using honeysuckle residue as raw material and the ferric chloride impregnation method. Batch Cr(VI) adsorption experiments were carried out using the modified honeysuckle-derived biochar (MHDB) as an adsorbent. The results indicate that a pH of 2 was best for the adsorption removal of Cr(VI) in the initial pH range of 2-10. The adsorption kinetic data fitted the pseudo-second-order model best out of the two models, and the Langmuir model was better than the Freundlich model to describe the adsorption process. Thermodynamic analysis indicated that the adsorption process of Cr(VI) on MHDB had an endothermic and spontaneous nature, and the increasing temperature was conducive to the adsorption. The main mechanisms of Cr(VI) adsorption might be the physical adsorption (electrostatic interactions) and chemical adsorption (ion exchange, the reduction of Cr(VI) to Cr(III)). The efficient adsorption of Cr(VI) makes MHDB a potential material for Cr(VI)-containing wastewater treatment. This study provides a feasible adsorption material for mitigating the environmental hazards of chromium, which has a certain reference value for protecting environmental health.

Dissociable Neural Representations of Adversarially Perturbed Images in Convolutional Neural Networks and the Human Brain.

Despite the remarkable similarities between convolutional neural networks (CNN) and the human brain, CNNs still fall behind humans in many visual tasks, indicating that there still exist considerable differences between the two systems. Here, we leverage adversarial noise (AN) and adversarial interference (AI) images to quantify the consistency between neural representations and perceptual outcomes in the two systems. Humans can successfully recognize AI images as the same categories as their corresponding regular images but perceive AN images as meaningless noise. In contrast, CNNs can recognize AN images similar as corresponding regular images but classify AI images into wrong categories with surprisingly high confidence. We use functional magnetic resonance imaging to measure brain activity evoked by regular and adversarial images in the human brain, and compare it to the activity of artificial neurons in a prototypical CNN-AlexNet. In the human brain, we find that the representational similarity between regular and adversarial images largely echoes their perceptual similarity in all early visual areas. In AlexNet, however, the neural representations of adversarial images are inconsistent with network outputs in all intermediate processing layers, providing no neural foundations for the similarities at the perceptual level. Furthermore, we show that voxel-encoding models trained on regular images can successfully generalize to the neural responses to AI images but not AN images. These remarkable differences between the human brain and AlexNet in representation-perception association suggest that future CNNs should emulate both behavior and the internal neural presentations of the human brain.

The application research of rainwater wetland based on the Sponge City.

In order to promote the construction of the Sponge City and strengthen the utilization of rainwater resources, this paper attempts to design a wetland that can effectively purify the rainwater. The rainwater quality of Zhengzhou was monitored to provide actual data for follow-up studies. A variety of wetlands with different plants and substrates were constructed to analyze the purification of wetlands on rainwater. The wetland with optimal parameters was selected to ensure the effluent can be reused. The average concentrations of Chemical Oxygen Demand (COD), Total Nitrogen (TN), Nitrate Nitrogen (NO3--N) and Ammonium Nitrogen(NH3-N) in the initial rainwater were 140.25 mg/L, 13.31 mg/L, 5.77 mg/L and 6.82 mg/L, respectively. The experimental results show that the efficiency of COD purification in each wetland is great, and the differences between wetland are small. Compared with other substrates (gravel, activated carbon, vermiculite), zeolite effectively enhanced the purification effect of wetland on ammonia nitrogen. The purification efficiency of wetland with reed and zeolite is the best, and the removal efficiency of COD, TN, NO3--N and NH3-N is 86.54%, 89.46%, 95.87% and 80.88%, the nitrogen removal efficiency of this wetland is greatly improved. Based on various reuse standards in china, wetland with reed and zeolite can effectively purify initial rainwater, and the effluent can be used to urban miscellaneous water, landscape water and industrial water. This study has important reference significance and practical value for the construction of rainwater wetland in the process promoting the Sponge City.

Long-pulse Nd:YAG 1064-nm laser treatment for onychomycosis.

BACKGROUND: Recent research shows that lasers can inhibit fungal growth and that Nd:YAG 1064-nm lasers can penetrate as deep as the lower nail plate. The aim of this study was to observe the effect of a long-pulse Nd:YAG 1064-nm laser on 154 nails of 33 patients with clinically and mycologically proven onychomycosis. METHODS: Thirty-three patients with 154 nails affected by onychomycosis were randomly assigned to two groups, with the 154 nails divided into three sub-groups (II degree, III degree, and IV degree) according to the Scoring Clinical Index of Onychomycosis. The 15 patients (78 nails) in group 1 were given eight sessions with a one-week interval, and the 18 patients (76 nails) in group 2 were given four sessions with a one-week interval. RESULTS: In group 1, the effective rates at 8 weeks, 16 weeks, and 24 weeks were 63%, 62%, and 51%, respectively, and the effective rates in group 2 were 68%, 67%, and 53% respectively. The treatment effect was not significantly different between any sub-group pair (P > 0.05). CONCLUSIONS: Long pulse Nd:YAG 1064-nm laser was effective for onychomycosis. It is a simple and effective method without significant complications or side effects and is expected to become an alternative or replacement therapy for onychomycosis.

A case of systemic amyloidosis beginning with purpura.

Primary systemic amyloidosis is a relatively rare disease, caused when abnormal extracellular deposition of fibrillary protein builds up in a variety of target organs, such as heart, kidneys, lungs liver, and so forth. The symptoms of the disease are usually vague, while many kinds of auxiliary or laboratory examinations especially pathologic biopsy can provide a clue for the diagnosis. Here we described a case who had purpura-like lesions in the initial stage, followed by progressive malfunctions in the kidneys, the heart, the lungs, as well as the liver. The final diagnosis was primary systemic amyloidosis determined by skin pathologic biopsy. And the disease led to a fatal outcome within three months after the diagnosis.